Shin Dong Ah, Huh Ryoong, Chung Sang Sup, Rock Jack, Ryu Samuel
Department of Neurosurgery, CHA University, Pochon, Republic of Korea.
Neurosurg Focus. 2009 Dec;27(6):E10. doi: 10.3171/2009.9.FOCUS09194.
Stereotactic radiosurgery (SRS) has become an important treatment alternative to surgery for a variety of spinal lesions. However, the use of SRS in the management of intradural intramedullary (IDIM) metastasis remains controversial. The aim of this study was to determine the clinical efficacy and safety of SRS for treatment of IDIM metastasis.
Nine patients with 11 IDIM metastases treated with SRS at Henry Ford Hospital were retrospectively reviewed. The mean age at presentation was 50 years, with a range of 14-71 years. There were 4 intradural extramedullary and 7 intramedullary lesions. The radiosurgery procedure used techniques of image-guided and intensitymodulated radiation. The mean treatment dose was 13.8 Gy, with a range of 10-16 Gy. All patients had clinical follow-up (except in 1 lesion), with an emphasis on initial symptoms and ambulatory status, and 8 patients (9 lesions) had imaging studies. The median follow-up duration was 10 months.
The presenting symptoms were improved in 8 (80%) of 10 evaluable lesions, unchanged in 1 case, and worsened in 1 case. Radiographic responses were seen as follows: complete response in 2 (22%) of 9; partial response in 3 (33%) of 9; stable disease in 3 (33%) of 9; and progressive disease in 1 (11%) of 9. After radiosurgery, 7 patients (78%) remained ambulatory until the last follow-up visit. The overall median survival time after SRS was 8 months, with a range of 2-19 months. No radiation toxicity was detected clinically during the follow-up period.
Despite the fact that this was a small series of patients with IDIM metastasis who had limited treatment options, SRS appears to be an effective and safe method of treating patients with these lesions.
立体定向放射外科（SRS）已成为多种脊柱病变手术治疗的重要替代方法。然而，SRS在硬脊膜内髓内（IDIM）转移瘤治疗中的应用仍存在争议。本研究的目的是确定SRS治疗IDIM转移瘤的临床疗效和安全性。
对亨利福特医院接受SRS治疗的9例患者的11个IDIM转移瘤进行回顾性分析。就诊时的平均年龄为50岁，范围为14至71岁。有4个硬脊膜外髓外病变和7个髓内病变。放射外科手术采用图像引导和调强放射技术。平均治疗剂量为13.8 Gy，范围为10至16 Gy。所有患者均进行了临床随访（1个病变除外），重点关注初始症状和行走状态，8例患者（9个病变）进行了影像学检查。中位随访时间为10个月。
10个可评估病变中的8个（80%）症状改善，1例无变化，1例恶化。影像学反应如下：9个病变中的2个（22%）完全缓解；9个病变中的3个（33%）部分缓解；9个病变中的3个（33%）病情稳定；9个病变中的1个（11%）病情进展。放射外科手术后，7例患者（78%）直至最后一次随访仍可行走。SRS后的总体中位生存时间为8个月，范围为2至19个月。随访期间未发现临床放射性毒性。
尽管这是一小系列IDIM转移瘤患者且治疗选择有限，但SRS似乎是治疗这些病变患者的一种有效且安全的方法。
